Why Caregivers Need to Plan for the Worst

Whether your loved ones live alone or in a nursing home, be ready to help them in case of disaster

The forecast for the next several years calls for more frequent natural disasters in every part of the country; a sharply rising population residing in nursing homes or assisted-living facilities, or living at home but less able to cope with an evacuation; and a startling lack of comprehensive disaster planning, both by family caregivers and health-care facility administrators.

In 1980, only about 100 "hydro-meteorological" disasters, like droughts, tsunamis, hurricanes, typhoons and floods were reported worldwide, according to Europe's Center for Research on Epidemiology of Disasters, which defines a disaster as an event that kills 10 or more people; leaves at least 100 injured, homeless, displaced or evacuated; or causes a national government to declare disaster or call for international assistance. That number has since more than tripled, to at least 300 per year since 2000.

“We’ve got the ‘storm of the century’ every year now,” Bill Gausman, a senior vice president and 38-year veteran of the Potomac Electric Power Company, recently told The New York Times. Although the most disaster-prone states are Texas, California, Oklahoma, New York, Florida, Louisiana, Alabama, Kentucky, Arkansas and Missouri, every region of the country has an inclination toward certain disasters, like earthquakes, forest fires, hurricanes or tornadoes.

In April, the federal Office of the Inspector General reported that 92 percent of the nation's 16,000 nursing homes had met federal emergency guidelines and that 72 percent had met the new federal training standards created after Hurricane Katrina. That was the good news. The bad news was what the agency discovered when it actually performed in-person evaluations at 24 randomly selected facilities in major disaster-prone states: 22 had no back-up plan for staff who could not get to the facility during a disaster; 15 had no information on hand about how to manage breathing tubes or oxygen tanks in case of a disaster; and not a single one had the federally mandated seven-day emergency supply of water for all residents.

More than three million Americans spent at least some time in a nursing home during 2009, according to the latest available data. Nearly 40 percent of them lived in the 10 most disaster-prone states. More than 50 percent of all assisted-living or skilled nursing facility residents have dementia or cognitive impairment that would likely lead them to be confused and unable to help themselves in a disaster scenario, according to the Alzheimer’s Association. And more than 13 million people age 50 or older would need help to evacuate their homes in a disaster, according to a 2005 Harris Poll. At least 139 nursing-home residents died in the days after Katrina hit because their facilities lacked proper plans or staff training.

What You Need to Know About Your Loved One's Residence

You need to know the emergency plans for the facility where your loved one resides, says Larry Minnix, chief executive of LeadingAge, an association of 6,000 not-for-profit organizations that support older Americans. Whether the potential emergency is a major storm, an on-site fire, or a bomb threat, federal law requires every nursing home to have an evacuation plan and to train its staff in the details.

Minnix advises that you ask the following questions of administrators at your loved one's facility:

What is your disaster plan? Please show me a copy.

How often is the staff drilled on your emergency procedures? (Ask this of both administrators and staff.)

Are there any chains on the facility's exit doors? (Facilities housing patients with dementia need to ensure that residents do not wander off. But chains are extremely dangerous during a panicked evacuation and should never be used. Exit doors should have a punch code so staff and administrators can open doors in an emergency. )

What is the facility’s supply of medications, food and water? (Again, federal guidelines mandate a seven-day emergency water supply.)

Does the facility have back-up generators in case of a power outage? (This is critical for residents on life-maintaining machines.)

Where would my loved one most likely be taken in an evacuation situation? Can I have the phone number of that facility?

It's important to know what a health-care facility plans to do in an emergency. But it's also important, Minnix says, for family members who live nearby to be willing to be part of the facility's emergency team. "Families should show up and ask what they can do to help," he says. "I’ve been involved in several disaster relief situations where family members became vital transportation providers or aided residents who were frightened during an evacuation."

Emergency Planning for Loved Ones Living at Home

In an emergency situation, law enforcement or the National Guard may prohibit you from getting to your parent or loved one's home. If you live far away, damage to power and phone lines may prevent you from communicating with them. So you need to prepare evacuation and communication plans for your loved one and share them with your family and circle of friends, in what Minnix calls "the big family pow-wow." The plan should include the following:

A list of contacts within your loved one's network, especially people he or she will want to try to reach if you are unavailable in an emergency. Make sure someone on the list lives more than 100 miles away — sometimes in an emergency situation it is easier to make long-distance connections than local calls.

Emergency instructions for caring for your loved one. Laminate a card with this information and put it in his or her purse or wallet: It can become a lifeline if your loved one is unconscious or unable to communicate with emergency personnel. The card should tell rescue workers to take your loved one's oxygen tank; wheelchair, walker or cane; refrigerated medications such as insulin or gamma globulin; and cell phone. If your loved one is deaf or hearing-impaired, the card should tell rescuers to write down what they are saying.

Where to find your loved one's “go quick” kit. You should prepare and maintain such a kit in his or her home with such essentials as a two-week supply of medications, a flashlight, a battery-operated radio, food and water for three days and other critical items — for example, an extra pair of contacts or eyeglasses; insulin tests and epi pens; a birth certificate, license or other form of identification; an insurance card and Medicare/Medicaid card; and $50 to $100 in cash. If your loved one has a service animal, the kit needs to include food and water to sustain it as well.

Remind your loved one always to tell you about his or her travel plans, and make sure you do the same. If you're going to be away, always have a designated person in your network ready to help out in case of emergency.

People of all ages sometimes refuse to leave their homes, even when evacuation is mandated. They may not believe a disaster is as serious as you tell them it is, or they may be fearful of leaving their home and possessions. This can be a major challenge for caregivers and rescue personnel. When you talk about emergency planning with your loved one, discuss the importance of following the community's evacuation plans. If you get resistance, consider bringing in a professional, like a geriatric care manager or perhaps a local firefighter or police officer — anyone who can help your loved one understand the potential seriousness of the situation.

These conversations need to take place before a disaster strikes to be of any use. As Winston Churchill said, “Failure to plan is planning to fail.”